In a home health proposed rule issued today, the Centers for Medicare and Medicaid Services (CMS) proposes additional regulatory flexibility regarding therapy documentation and reassessment as well as face-to-face encounter requirements. In addition, the rule would reduce Medicare payments to home health agencies in calendar year (CY) 2013 by 0.1%, or $20 million.

Proposed revisions regarding documentation and reassessment include:

Revising the regulations to state that if a qualified therapist missed a reassessment visit, therapy coverage would resume with the visit during which the qualified therapist completed the late reassessment. This would be a change from the current policy that does not allow payment for the late reassessment visit.

Amending the regulations to state that in cases where multiple therapy disciplines are involved, if the required reassessment visit was missed by any 1 of the therapy disciplines, therapy coverage would cease only for that particular therapy discipline. Under current policy therapy coverage would cease for all disciplines until reassessments are completed by all therapy disciplines involved in care.

Modifying the regulations to clarify that in cases where the patient is receiving more than 1 type of therapy, qualified therapists could complete their reassessment visits during the 11th, 12th, or 13th visit for the required 13th visit reassessment and the 17th, 18th, or 19th visit for the required 19th visit reassessment.

CMS proposed to change the regulations to allow a nonphysician practitioner in an acute or post-acute facility to perform the face-to-face encounter in collaboration with or under supervision of the physician who has privileges and cared for the patient in the acute or post-acute facility. This will inform the decision regarding the patient’s homebound status and need for skilled services.

In addition, this proposed rule includes provisions regarding quality reporting for hospice and provides updates to the home health quality reporting program. This rule also would establish requirements for unannounced, standard, and extended surveys of home health agencies (HHAs) and provide alternative sanctions if HHAs are out of compliance with federal regulations.

APTA will provide members with a thorough analysis of the proposed rule shortly. The association will submit comments to CMS by the September 4deadline. A final rule will be issued on or around November 1 and provisions will become effective in 2013.

Comments

It's a start to a regulation with good intention, but poor execution.

Posted by Andrea
on 7/7/2012 7:26 AM

While I understand the regulatory need for reassessment frequency minimums, this is still a difficult issue for tracking when PT sees the patient at the end of three weeks (9 visits)...and sometimes sooner for a client that has additional needs for re-assessments..( Ie arrival of a brace, or poor fitting device, or change in status per PTA report, resumption of care, just to name a few) and then just to meet a nebulous number, needs to go out to see client one to two visits later(sometimes the very next visit) to meet a "rule"... This may be an issue for companies/PT's that DO NOT follow patients closely, but this seems like a "game" to get out of payments when the therapist closely follows the caseload status (the physical status, that is, not just the "numbers" and "paper charting") At least this is a little change, but not enough

Posted by jane matz,PT
on 7/7/2012 10:20 AM

in states where PT needs to see patients every 10th day this rule for reassessment is redundant, if reassessments are performed every 10th day

Posted by Hendrika Hekker
on 7/7/2012 8:53 PM

Would like clarification on what is a multidiscipline case. If OT was in for visit 1 and 2, then PT does 3-13, can RA be performed in the 11 to 13th visit window or must it be on visit 13 because OT is out?

Posted by Laurie Brogan -> =MYc<
on 7/11/2012 5:33 PM

Tracking is tedious and consumes hours of time that would be best spent with our patients, training our clinical team, and improving clinical performance, ex: PI processes. I do believe the RAs assist with patient care; but,they should not be all consuming. The proposed changes will release hours to permit us to return to what is truly important. I am in favor.

Posted by Kathy Rohaley, VA PT
on 7/13/2012 1:38 PM

Forcing the reassessments for exact 3 days in row causes disciplines to make unnecessary visits or hold up others. Patients have different visit patterns for PT, OT, and ST depending on their needs so this has a negative impact on patient care. It also causes an increase in office staff coordination, especially for larger agencies, which drives up the cost of care. Neither scenarios are in the best interest of the patient or the industry.